DecisionDx-Melanoma (Castle test): When is it necessary?

@birdman518 I also have had melanoma surgery, but was not given any information on this test, nor the company.

It seems you need to look at your case specifically. Your age, what stage was the melanoma they removed, how deep was it, any post surgery treatment suggested by the surgeons. In regards to the Castle test, is this something your insurance will cover, or are you on the hook for it completely? If you need to pay for it, what is the cost and how accurate is it? Does your doctor have any other patients who did the test and were satisfied with the results?

Your plan to reach out to the surgeon sounds like a sound one, to me. Let me know what they say!
Ginger

Ginger, thanks for your response. Since my oncologist/surgeon already did a SLN excision (all clear) I suspect they may say it is not necessary.

@birdman518 - I wonder if your original dermatologist might think the test could provide some additional information or possible treatment options for you? Here's some information I found that may shed some light on the topic and help or confirm your reasoning.

Integrating 31-Gene Expression Profiling With Clinicopathologic Features to Optimize Cutaneous Melanoma Sentinel Lymph Node Metastasis Prediction:
-- https://ascopubs.org/doi/full/10.1200/PO.21.00162
Molecular Biomarkers for Melanoma Screening, Diagnosis and Prognosis: Current State and Future Prospects
-- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8085270/
Uveal Melanoma Patient Attitudes Towards Prognostic Testing Using Gene Expression Profiling
-- https://iovs.arvojournals.org/article.aspx?articleid=2775691

I did run this by my oncologist and he stated that I do not need this. Remember that I had my melanoma excised AND had my SLN biopsied... all is now considered clear.

I got a notification from my health insurance company that there was a new claim. I checked it, and it was for this test - to the tune of $8500. I thought it was an decimal since any lab tests on my insurance are only an $85 co-pay. They denied the claim because it's not a coverable test. I just got a statement from Castle Biosciences explaining what this test is, and I looked it up. I never authorized this test. I had a melanoma. It was removed. My doctor sent it to have this test done without my authorization. It's still considered experimental - Medicare will cover up to $7193 of the $8500. However, I'm not old enough to qualify for Medicare yet. So it looks like my doctor stuck me with a test I didn't authorize, for something that isn't proven to be useful, and I'm going to be on the hook for $8500. Because it's not a coverable test, it doesn't even count toward my yearly out of pocket on my insurance.

I don't have $8500. I am on social security, three years away from being eligible for Medicare. If I gave them 100% of my social security check every month I'll be homeless, but I'll have the bill paid within a year. This is so bogus. I'm SO angry. No wonder old people have anxiety. And - if I was poor enough to qualify for a free lawyer, or rich enough to pay for one, I wouldn't be griping.

@teintnatural Welcome to Mayo Clinic Connect.

I'm saddened to hear your doctor went ahead with a test without your authorization. You should not/cannot be held financially responsible for a test you had no knowledge of, let alone one you didn't okay. I would go back to your doctor's office and explain the situation to them, and tell them you have no intention on paying for this test.

Why did the doctor even go forward with this test?
Ginger

I don't know why he did this particular test. He knew it was my second melanoma in two months, he's the one who did the slow-Mohs on the first one.

@teintnatural, I know this is the last thing that you want to be dealing with at this time. If you don't get a resolution from your provider, please reach out to Castle Biosciences (https://castlebiosciences.com/resources/test-reimbursement-2/). These companies are used to dealing with denials. This type of biomarker testing is helpful in determining the driver of many cancers today, but many insurance companies will deny claims. The results of these tests can drive treatment decisions.
I had this type of test for lung cancer. At the time, I wasn't aware that the test was being sent to a third-party lab. The results of the test were very beneficial for me, I am thankful that the tests were run. My insurance carrier denied the claim as 'experimental', even though many states are passing legislation requiring payment for this type of testing. After the denial, I did receive a letter from the biomarker testing company, they fought for payment on my behalf. I did have to authorize them to do that, but then I never heard anything about it again. So, either the insurance company paid, OR the company waived the fee. Best of luck to you.

It's not covered -at all- on my insurance. It's out of network, it isn't an approved test, it's experimental, and I never authorized my doctor to submit the sample for genetic testing.

I won't pay the bill, and I won't ask my insurance company to pay it either. That's what drives up premiums for everyone - insurance companies that pay for things that aren't authorized. The doctor slipped this test in without my knowledge or consent, the doctor can pay for it.

Important to include this: If the doctor had asked me for consent to do this test, I would have said NO. I do not want genetic testing. At all. I would have told him very emphatically - do NOT send this for genetic testing. I'm very angry that he ran this test without my knowledge or consent.

I’m so sorry that happened to you. Call the lab company and ask them if they have any low income program, something that will help you pay this bill. Some of these labs do and it might even cover the whole bill. Good luck.